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Realize agility through a modern digital infrastructure

A Q&A on digital innovation and how it can help organizations deliver on business and patient care goals

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Accelerating digital infrastructure and innovation

An agile, scalable and secure digital infrastructure fosters core business technology adoption, ingenuity and speed to value. It also drives efficiency for consumers, clinicians and back-office staff.

Scott Gaydos, Vice President of Product, Optum, leads a team supporting the portfolio of technology-enabled services that helps organizations power their information technology needs with respect to digital infrastructure.

We sat down with Scott to discuss how he defines digital infrastructure and learn how modernization can help foster and achieve health systems’ business and patient care goals.

How would you define digital infrastructure?

I'd define digital infrastructure as the business strategy an organization uses to drive very different engagement models with its customers, employees, suppliers and partners — all supported by a series of technologies that enable those engagements.

Simply put, it’s a combination of both the business strategy and its supporting, corresponding technology strategies and solutions.

IT can have a far-reaching impact on so many facets of health care. What are some areas where you feel IT can drive the most change?

There are a lot of use cases, but I’ll call out a couple.

First, let's look at what we’ve previously called customer engagement. If you're a health system, that means patient engagement. There are lots of activities underway across various health systems to help drive new and different relationships with patients. These touch everything from registration and appointment scheduling to at-home monitoring and medication adherence.

The entire engagement cycle that a health system has with its patients is one area where proper IT can make a huge difference.

The other area is within the supplier and partner space. Consider the way a health system interacts with payers. That’s a complex web of eligibility verification, benefits authorization, bill coding and payments. The amount of friction that can create between providers and payers is huge, with the patient stuck in the middle.

Over time, IT is going to help make those interactions seamless and more transparent. That requires both a business strategy for revamping those interactions and the appropriate technologies underneath to power that change.

Take the next step on your digital journey

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Where do you think most hospitals and health systems are on their digital journey? Do you think most have a well-baked, formal roadmap?

I would say that most hospitals are still early in their digital journey. Many have some form of roadmap — whether it's formally written down and coordinated or a series of planned projects to make digital progress.

Having said that, most of these organizations also have a mountain of technology debt — legacy technical decisions made to expedite design and delivery that now require reinvestment to undo or evolve — that they're constantly digging out from. All of this must be balanced against investments in their digital journey.

What are some of the health care IT trends you are seeing that support the digital journey? Are you surprised by any of them?

One of the first things that comes to mind in this space is automation. Automation is one of those key trends that is inherent to a digital journey, so there are many different technologies that support automation. But ensuring a focus on automation itself is essential to creating the efficiencies needed to enable digital transformation.

Another trend worth calling out is the effective leveraging of cloud technologies. This must be done to have success in a digital journey. The amount of innovation necessary for a digital transformation and the speed to deliver requires organizations to figure out how they're going to leverage public, private and hybrid cloud technologies.

Finally, while we're talking about trends, we must focus on security. This isn’t a new trend. But with the rampant spread of things like phishing attacks, ransomware and other security breaches, enhanced focus on security couldn't be timelier — especially when considering the digital journey.

Do you see these trends as blips on the radar or more long-term?

The trends themselves are likely persistent given what they are, but what does change is the underlying technology. That technology is necessary to support or accelerate trends. So the trends themselves are persistent, but tech is always changing.

What are some of the top challenges or obstacles to the successful implementation of IT to deliver value in health care?

Organizations always have obstacles in executing their strategies. To answer this question, it’s important to think about digital strategies as business strategies supported by technology.

One challenge is the disconnect — whether it's intentional or accidental — between an organization’s business strategy, IT and the supporting technology projects and investments. These things aren't always aligned because IT and technology are sometimes viewed as "back-office" and not directly related to the strategy of a business.

Sometimes there’s inertia in the organization to make the hard business and technology changes to deliver on the value promised by digital transformation.

Other obstacles can be technology debt and the tremendous amount of process debt, which can paralyze organizations against change. It can be hard to find the time, skills and resources to drive necessary digital changes when everybody is at or over capacity just maintaining the status quo.

How critical is it to optimize an electronic health record (EHR) system for both care delivery and business goals?

A provider organization’s chosen EHR system is generally the center of their clinical IT universe, so its effective integration with clinical and administrative workflows is paramount to organizational success. Getting the technology and its integrations right is key, but getting the workflows right is even more important to support care delivery and business goals.

What are some of the challenges when standing up telehealth or digital front door initiatives and how can IT be an enabler?

Digital front door is a newer term, but telehealth — both the term and technology — has been around for a long time. Telehealth is a great example to consider when thinking about challenges.

Let’s roll back the clock to the early days of the COVID-19 pandemic. Some organizations had a long history with telehealth, but they might have had five to 10 telehealth visits a week. Then, COVID-19 struck and everything went virtual. That organization’s five to 10 telehealth visits per week jumped to 2,000 per day.

Most technology makes considerations for scaling, but it’s hard to prepare for the jumps of the scale we saw. As we start to look at some of the newer things we’re associating with digital front door initiatives, we must consider the varying technologies needed to ensure proper scale.

Another challenge inherent in health care is the secure handling of protected health information and personally identifiable information — especially across digital engagements like telehealth and digital front door scenarios.

The technologies required to enable these kinds of use cases aren't generally housed within the four walls of an organization or its data centers. Planning for and implementing proper privacy and security controls can be a huge challenge in this space.

What might be some of the solutions to those challenges?

On the scale side, I come back to effective leveraging of cloud technologies. Nearly unlimited scale is one of the primary benefits of these technologies. But the cloud’s unlimited scale can also be bad because scale isn't free. That’s why I'd stress that proper use of cloud technology is key to enabling the necessary scale, while at the same time managing the operational finances of cloud implementations.

On the privacy and security side, you must ensure you have the right services at play. Managing security for the sake of compliance isn't nearly enough. Having a firewall protecting your on-premises infrastructure isn't enough.

You want to make sure that you have the right mix of services deployed, including federated identity management, proactive threat and vulnerability management, and effective security incident management, to name a few.

What do you think are some of the most important IT infrastructure investments health systems can make over the next few years?

I'll reiterate the importance of effective investments in cloud technology and security solutions. Beyond those, we can't discount the need to invest in the management and evolution of the application ecosystem on which providers rely.

The EHR system is the center of the clinical IT universe. But there’s more than the EHR to consider, like the ancillary clinical applications, the entire administrative technology ecosystem and the proliferation of digital solutions that span those components.

Providers must invest to effectively manage this universe of applications and evolve it — whether through buying new solutions or building those that don’t exist.

How have the current health care industry workforce challenges impacted organizations and their ability to attract and retain top IT talent?

There are many industries like health care IT that are facing workforce challenges. This is partly because the pandemic has created a shortage of workforce in certain places. But it's also created new possibilities for new kinds of work, enticing workers to move from their current roles into new ones.

The health aspect of this pandemic is likely to heal in time. But the competition for IT talent, who can generally work from anywhere supporting anyone, is going to be with us for a long time.

Organizations need to provide the most interesting projects and the most interesting journeys to excite staff about where the organization is going.

Thinking about the next 12 to 18 months, what are two or three of the most impactful things health care leaders, particularly IT leaders, can do to improve the system for providers, patients and the communities they serve?

First, be sure to link the business strategy and technology strategy together. Either could be done independently, and that will help to make some progress. But without both explicitly linked to one another, digital transformation isn't possible.

Next, figure out how you’ll leverage cloud services in a privacy- and security-safe manner. Then invest properly in both, as well as the application support ecosystem wrapped around clinical and administrative technologies.

Last, look for help. This work is quite hard and each organization's journey is somewhat different. There are different business strategies, different technologies and different workforce situations. Find a partner that can support your priorities and enhance your organization’s ability to deliver on the promises of digital transformation to meet the needs of your communities.

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About Scott Gaydos, Vice President of Product, Optum

Scott Gaydos provides strategic direction for Optum Commercial IT Performance Services, and leads the exploration, development, cultivation and execution of new IT services products that drive digital value for Optum customers. The portfolio he oversees includes infrastructure, platform, cloud services, security services, IT professional services, application services and market services.

Gaydos brings nearly 30 years of health care IT experience and has served in numerous senior positions including CTO, CIO and engineering leadership for a number of organizations. He has a degree in management information systems from Penn State University.

Tag: Providers, Health care operations, Articles and blogs, financial performance, IT Performance Services, Advisory services

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